by Anne Eglash MD, IBCLC, FABM
Many breastfeeding mothers are on medications to reduce blood pressure. Sometimes the blood pressure medications are needed short term due to pre-eclampsia, but other mothers have a pre-pregnancy history of high blood pressure, and need to stay on medications during pregnancy and postpartum. There are several medication options to treat high blood pressure during lactation, so how is a health care provider to decide?
Dr. Phil Anderson, who writes a column called Lactmed Update in Breastfeeding Medicine Journal, addressed this topic in the journal’s March 2018 issue, and makes clear recommendations.
- Diuretics in high doses can decrease the milk supply.
- Among the ACE inhibitors, lisinopril is considered much safer than benazepril and captopril.
- Labetolol, a beta blocker often used for high blood pressure during pregnancy, is safer to continue postpartum for a breastfeeding mother than atenolol.
- The most studied calcium channel blocker during lactation is nifedipine, which has never been shown to cause infant side effects.
- Guanfacine, a blood pressure medication often used to control anger outbursts in children, has been shown to be safe for mothers and infants during lactation.
See the Answer
IABLE Comment by Anne Eglash MD, IBCLC, FABM
It is reasonable to avoid guanfacine for hypertension during lactation because we have no evidence regarding its effect on infants, and it might have a negative effect on a mother’s prolactin level.